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Breastfeeding and respiratory outcomes from infancy to school-age: pathways and temporal sequence

English title Breastfeeding and respiratory outcomes from infancy to school-age: pathways and temporal sequence
Applicant Kühni Claudia
Number 144068
Funding scheme Project funding (Div. I-III)
Research institution Institut für Sozial- und Präventivmedizin Universität Bern
Institution of higher education University of Berne - BE
Main discipline Paediatrics
Start/End 01.10.2012 - 30.09.2015
Approved amount 420'017.00
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All Disciplines (3)

Discipline
Paediatrics
Respiratory Diseases
Methods of Epidemiology and Preventive Medicine

Keywords (10)

breastfeeding; infant; rhinitis; asthma; atopy; cohort; wheeze; lung function; paediatrics; epidemiology

Lay Summary (English)

Lead
Lay summary

Breathing problems, particularly respiratory infections and allergic disorders, are important health problem in childhood and a major cause of visits to the general practitioner and hospital stays. Thus, they contribute significantly to health care costs. Breastfeeding has many benefits for maternal and child health. Whether it has also beneficial effects on lung growth, respiratory infections and the development of allergic disorders is insufficiently understood.

The objectives of this research project are: (i) To study whether breastfeeding affects  lung growth and function, analyzing data from three independent longitudinal (cohort)  studies; (ii) to investigate whether breastfeeding influences the occurrence of respiratory disease  during the first year of life, using weekly data on respiratory symptoms and infections; (iii) to investigate the intermediate pathways (early infections, allergy) through which breastfeeding affects respiratory outcomes (asthma, hayfever, lung function) at school age, using a statistical method called path analysis.

We believe that this project will add significantly to the current knowledge of effects of breastfeeding on respiratory illness and lung development in children. In view of the high relevance of breastfeeding for public health and the rising asthma prevalence in many countries our results will be likely to inform policy.
Direct link to Lay Summary Last update: 21.02.2013

Responsible applicant and co-applicants

Employees

Publications

Publication
Asthma phenotypes in childhood: conceptual thoughts on stability and transition.
Spycher Ben Daniel, Kuehni Claudia Elisabeth (2016), Asthma phenotypes in childhood: conceptual thoughts on stability and transition., European Respiratory Society, United Kingdom.
Primary ciliary dyskinesia: the patients grow up.
Kuehni Claudia E, Goutaki Myrofora, Carroll Mary, Lucas Jane S (2016), Primary ciliary dyskinesia: the patients grow up., European Respiratory Society, United Kingdom.
"Attacks" or "Whistling": Impact of Questionnaire Wording on Wheeze Prevalence Estimates.
Pescatore Anina M, Spycher Ben D, Beardsmore Caroline S, Kuehni Claudia E (2015), "Attacks" or "Whistling": Impact of Questionnaire Wording on Wheeze Prevalence Estimates., in PloS one, 10(6), 0131618-0131618.
Bed-sharing and childhood asthma: from associations to causal modelling.
Ramette Alban, Kuehni Claudia (2015), Bed-sharing and childhood asthma: from associations to causal modelling., European Respiratory Journal (ERJ), United Kingdom.
Breastfeeding, lung volumes and alveolar size at school-age.
Dogaru Cristian M, Narayanan Manjith, Spycher Ben D, Pescatore Anina M, Owers-Bradley John, Beardsmore Caroline S, Silverman Michael, Kuehni Claudia E (2015), Breastfeeding, lung volumes and alveolar size at school-age., in BMJ open respiratory research, 2(1), 000081-000081.
Environmental and socioeconomic data do not improve the Predicting Asthma Risk in Children (PARC) tool.
Pescatore Anina M, Spycher Ben D, Jurca Maja, Gaillard Erol A, Kuehni Claudia E (2015), Environmental and socioeconomic data do not improve the Predicting Asthma Risk in Children (PARC) tool., in The Journal of allergy and clinical immunology, 135(5), 1395-1397.
Lung function in the children of immigrant and UK-born south-Asian mothers.
Kuehni Claudia E, Strippoli Marie-Pierre F, Spycher Ben D, Silverman Michael, Beardsmore Caroline S (2015), Lung function in the children of immigrant and UK-born south-Asian mothers., in The European respiratory journal, 45(4), 1163-6.
A simple asthma prediction tool for preschool children with wheeze or cough.
Pescatore Anina M, Dogaru Cristian M, Duembgen Lutz, Silverman Michael, Gaillard Erol A, Spycher Ben D, Kuehni Claudia E (2014), A simple asthma prediction tool for preschool children with wheeze or cough., in The Journal of allergy and clinical immunology, 133(1), 111-118.
Breastfeeding and childhood asthma: systematic review and meta-analysis.
Dogaru Cristian M, Nyffenegger Denise, Pescatore Aniña M, Spycher Ben D, Kuehni Claudia E (2014), Breastfeeding and childhood asthma: systematic review and meta-analysis., in American journal of epidemiology, 179(10), 1153-67.
Copy number variation of the beta-defensin genes in europeans: no supporting evidence for association with lung function, chronic obstructive pulmonary disease or asthma.
Wain Louise V, Odenthal-Hesse Linda, Abujaber Razan, Sayers Ian, Beardsmore Caroline, Gaillard Erol A, Chappell Sally, Dogaru Cristian M, McKeever Tricia, Guetta-Baranes Tamar, Kalsheker Noor, Kuehni Claudia E, Hall Ian P, Tobin Martin D, Hollox Edward J (2014), Copy number variation of the beta-defensin genes in europeans: no supporting evidence for association with lung function, chronic obstructive pulmonary disease or asthma., in PloS one, 9(1), 84192-84192.
Dogaru et al. respond to "Does breastfeeding protect against 'asthma'?".
Dogaru Cristian M, Nyffenegger Denise, Pescatore Aniña M, Spycher Ben D, Kuehni Claudia E (2014), Dogaru et al. respond to "Does breastfeeding protect against 'asthma'?"., in American journal of epidemiology, 179(10), 1171-2.
Increased prevalence of pre-school wheeze is not explained by time trends in body mass index.
Goutaki Myrofora, Pescatore Anina M, Singh Parvinder, Beardsmore Caroline S, Kuehni Claudia E (2014), Increased prevalence of pre-school wheeze is not explained by time trends in body mass index., in The European respiratory journal, 44(4), 1078-82.
Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children.
Kuehni Claudia &, Dogaru Cris (2014), Preterm birth, infant weight gain, and childhood asthma risk: a meta-analysis of 147,000 European children., in Journal of Allergy and Clinical Immunology, 1317.
Reply: On the use of 3He diffusion magnetic resonance as evidence of neo-alveolarization during childhood and adolescence.
Narayanan Manjith, Owers-Bradley John, Beardsmore Caroline S, Kuehni Claudia E, Silverman Michael (2014), Reply: On the use of 3He diffusion magnetic resonance as evidence of neo-alveolarization during childhood and adolescence., in American journal of respiratory and critical care medicine, 189(4), 502-4.
A prospective study of the impact of air pollution on respiratory symptoms and infections in infants
Stern Georgette, Stern Georgette, Latzin Philipp, Röösli Martin, Fuchs Oliver, Fuchs Oliver, Proietti Elena, Proietti Elena, Kuehni Claudia, Frey Urs (2013), A prospective study of the impact of air pollution on respiratory symptoms and infections in infants, in American Journal of Respiratory and Critical Care Medicine, 187(12), 1341-1348.
Catch-up alveolarization in ex-preterm children: evidence from (3)He magnetic resonance.
Narayanan Manjith, Beardsmore Caroline S, Owers-Bradley John, Dogaru Cristian M, Mada Marius, Ball Iain, Garipov Ruslan R, Kuehni Claudia E, Spycher Ben D, Silverman Michael (2013), Catch-up alveolarization in ex-preterm children: evidence from (3)He magnetic resonance., in American journal of respiratory and critical care medicine, 187(10), 1104-9.
Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts.
Spycher Ben D, Silverman Michael, Pescatore Anina M, Beardsmore Caroline S, Kuehni Claudia E (2013), Comparison of phenotypes of childhood wheeze and cough in 2 independent cohorts., in The Journal of allergy and clinical immunology, 132(5), 1058-67.
Etiology of Ethnic Differences in Childhood Spirometry
Strippoli Marie-Pierre Françoise, Kuehni Claudia Elisabeth, Dogaru Cristian Mihai, Spycher Ben Daniel, McNally Teresa, Silverman Michael, Beardsmore Caroline Sarah (2013), Etiology of Ethnic Differences in Childhood Spirometry, in Pediatrics, e1842-e1849.
Alveolarization continues during childhood and adolescence: New evidence from helium-3 magnetic resonance
Narayanan Manjith, Owers-Bradley John, Beardsmore Caroline S., Mada Marius, Ball Iain, Garipov Ruslan, Panesar Kuldeep S., Kuehni Claudia E., Spycher Ben D., Williams Sian E., Silverman Michael (2012), Alveolarization continues during childhood and adolescence: New evidence from helium-3 magnetic resonance, in American Journal of Respiratory and Critical Care Medicine, 185(2), 186-191.
Breastfeeding and lung function at school age: Does maternal asthma modify the effect?
Dogaru Cristian M., Strippoli Marie Pierre F, Spycher Ben D., Spycher Ben D., Frey Urs, Beardsmore Caroline S., Silverman Michael, Kuehni Claudia E. (2012), Breastfeeding and lung function at school age: Does maternal asthma modify the effect?, in American Journal of Respiratory and Critical Care Medicine, 185(8), 874-880.
Early growth characteristics and the risk of reduced lung function and asthma: a metaanalysis of 25,000 children
Devereux Graham Stuart, Early growth characteristics and the risk of reduced lung function and asthma: a metaanalysis of 25,000 children, in Journal of Allergy and Clinical Immunology.

Collaboration

Group / person Country
Types of collaboration
Basel-Bern Infant Lung Development (BUILD) study/University Children’s Hospital, Basel Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Universitätsklinik für Kinderheilkunde, Inselspital, Bern Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Avon Longitudinal Study of Parents and Children (ALSPAC) - University of Bristol Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
MAS - Multizentrische Allergiestudie/Universitätsmedizin Berlin Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Institute for Social and Preventive Medicine, University of Ber Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Department of Infection, Immunity and Inflammation (Child Health) University of Leicester Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
European Respiratory Society Annual Congress 2015 Talk given at a conference Does breastfeeding protect against childhood eczema? 26.09.2015 Amsterdam, Netherlands Halbeisen Florian; Ramette Alban; Jurca Maja; Wang Jingying; Kühni Claudia;
European Respiratory Society Annual Congress 2015 Poster Causal relationships between infections and asthma throughout childhood: a path analysis approach 26.09.2015 Amsterdam, Netherlands Ramette Alban; Kühni Claudia;
European Respiratory Society Annual Congress 2015 Talk given at a conference Risk factors for chronic non-specific cough in 0-2 year olds: A cohort study 26.09.2015 Amsterdam, Netherlands Latzin Philipp; Ramette Alban; Wang Jingying; Jurca Maja; Kühni Claudia;
European Respiratory Society Annual Congress 2014 Poster Association of breastfeeding and respiratory infections in infants 06.09.2014 Munich, Germany Jurca Maja; Kühni Claudia; Pescatore Anina; Cristian Dogaru;
European Respiratory Society Annual Congress 2014 Poster Characteristics of cough in adolescents with different ENT disorders 06.09.2014 Munich, Germany Latzin Philipp; Kühni Claudia; Cristian Dogaru; Pescatore Anina; Jurca Maja;
Schweizerischen Gesellschaft für Pneumologie 2014 Talk given at a conference Prevalence of cough throughout childhood: a cohort study. 12.06.2014 Basel, Switzerland Latzin Philipp; Kühni Claudia; Cristian Dogaru; Jurca Maja; Pescatore Anina;
European Respiratory Society Annual Congress 2013 Poster Do changes in body mass index explain temporal trends in prevalence of wheeze and asthma? 07.09.2013 Barcelona, Spain Cristian Dogaru; Pescatore Anina; Kühni Claudia;
European Respiratory Society Annual Congress 2013 Poster Questions used to assess chronic cough in epidemiological surveys 07.09.2013 Barcelona, Spain Kühni Claudia; Latzin Philipp; Pescatore Anina; Cristian Dogaru; Jurca Maja;
European Respiratory Society Annual Congress 2013 Poster Breastfeeding and rhinoconjunctivitis: A cohort study 07.09.2013 Barcelona, Spain Cristian Dogaru; Pescatore Anina; Kühni Claudia;
European Respiratory Society Annual Congress 2013 Poster Predicting later asthma in toddlers: do environmental exposure data improve a clinical tool? 07.09.2013 Barcelona, Spain Kühni Claudia; Pescatore Anina; Cristian Dogaru;


Associated projects

Number Title Start Funding scheme
122341 Breastfeeding and the risk of childhood asthma: a population-based study 01.05.2009 Project funding (Div. I-III)
162820 Phenotypes and prognostic modelling in childhood asthma: moving towards clinical applications 01.10.2015 Project funding (Div. I-III)
137033 Defining phenotypes and risk factors of chronic non-specific cough in children 01.10.2012 ProDoc
162820 Phenotypes and prognostic modelling in childhood asthma: moving towards clinical applications 01.10.2015 Project funding (Div. I-III)

Abstract

Background: There is an ongoing debate about whether and how breastfeeding (BF) affects lung growth, the risk of upper and lower respiratory infections and the development of atopic disorders including allergic rhinitis and asthma. Results from previous studies are heterogeneous, differ by disease phenotype and age when respiratory outcomes were assessed and suggest effect modification by maternal atopy. The primary and secondary research performed in the last grant period produced exciting results, which now need to be validated in independent datasets and for which potential causal pathways need to be identified, for example the role of upper and lower respiratory infections and atopy. Our analyses of lung function data from the Leicester 1998 cohort found that spirometric lung function at school age was better in breastfed children, particularly those with asthmatic mothers (Dogaru AJRCCM 2012, doi 10.1164/rccm.201108-1490OC). We then complemented lung function measurements by plethysmography and 3He magnetic resonance, a novel method to estimate alveolar dimensions (Narayanan AJRCCM 2012;185:186-91). Again, breastfed children tended to have increased lung volumes, higher flows and larger alveolar dimensions, particularly if their mothers had asthma (manuscript in preparation). Finally, in a systematic review and meta-analysis of 38 cohort studies from developed countries we found a protective effect of BF on development of asthma and wheeze in early life that diminished with age. Objectives: The proposed project will expand the previous work. In particular, we will: (i) test the robustness of our findings on BF and lung function in three independent cohorts and extend these analyses to lung growth; (ii) investigate associations between BF and respiratory outcomes in infancy, using weekly data on symptoms, infections and respiratory rate; (iii) investigate pathways (early infections, atopy) between BF and respiratory outcomes (asthma, allergic rhinitis, lung function) at school age, using a path analysis, that accounts for direct and mediated effects and their temporal sequence.Methods: In Part i) We will analyse the association between BF and lung function in three independent childhood cohorts (Leicester 1990, N=480; German Multicentre Allergy Study [MAS], N=650; and Avon Longitudinal Study on Parents and Children [ALSPAC], N=7000). We will also look at changes in lung function between age 5 weeks and 6 years using repeated lung function data from the Bern Infant Lung Development (BILD) cohort (N=250). In Part ii) We will analyse prospectively assessed weekly data on BF and respiratory outcomes (symptoms, infection, respiratory rate) in infancy from the BILD cohort (N=450). In Part iii) Using a path analysis of repeated measurements from the Leicester 1998 cohort (N=4000), we will simultaneously model asthma and allergic rhinitis at age 9-13 years and intermediate outcomes at younger ages. This analysis allows the temporal sequence to be investigated and the direct effects of BF and indirect effects mediated through infections and atopy to be distinguished. In a subsample we will apply the same model to lung function and skin prick test response at age 9-13 years (N=1500). Output and significance: We believe that this project will add significantly to the current knowledge of effects of BF on respiratory morbidity and lung development in children. Importantly, we will use a standardised approach to analysis, describe changing effect sizes with increasing age and avoid or minimise methodological pitfalls of earlier studies. The detailed information on respiratory infections and atopy in our cohort datasets will allow causal pathways to be explored and hypotheses regarding potential mechanisms to be generated. Our study is topical in view of the high public health relevance of BF and the rising asthma prevalence in many countries, and results will be likely to inform policy.
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